Previous psychopathology predicted severe COVID-19 concern, anxiety and PTSD symptoms in pregnant women during lockdown in Italy

Italy was the first COVID-19 pandemic epicenter among European countries and established a period of full lockdown, consisting of travel bans, mandatory staying at home and temporary closure of non-essential businesses. Similar measures are known risk factors for psychological disturbances in the general population, still very little is known about their impact on pregnant women’s mental health during COVID-19 pandemic.

The national survey “COVID-19 related Anxiety and StreSs in prEgnancy, poSt-partum and breaStfeeding” (COVID-ASSESS) was conducted during the first month of full lockdown in Italy. The questionnaire was specifically developed to examine COVID-19 concerns and included the psychometric tests NSESSS for PTSD and STAI-Y for anxiety. A multivariable logistic regression model was fitted to explore the association of the concern, anxiety and PTSD symptoms with age, gestational weeks, parity, days of lockdown, assisted reproductive technology use, psychopathological history and previous perinatal losses.

Out of 1015 pregnant women reached, 737 (72.6%) fully answered the questionnaire; no woman reported a COVID-19 infection. Median age was 34.4 years [quartiles 31.7, 37.2], median days in lockdown were 13.1 [11.0, 17.0], median gestational weeks were 27.8 [19.8, 34.0]. Clinically significant PTSD symptoms were present in 75 women (10.2%, NSESSS cut-off 24) and clinically significant anxiety symptoms were present in 160 women (21.7%, STAI-Y1 cut-off 50). Women were less worried about their own health than the health of their baby and of their elderly relatives. Previous anxiety predicted higher concern and PTSD symptoms; previous depression and anxiety were independently associated with current PTSD symptoms.